NSG 6440 Predictor STUDY GUIDE
QUESTIONS WITH
ANSWERS(SCORES 100%)
Course
Predictor
Question 1
A 58-year-old man with a history of hypertension presents with crushing substernal chest pain
radiating to his left arm for 45 minutes. His ECG demonstrates ST-segment elevation in leads II,
III, and aVF. What is the priority intervention?
A. Begin oral aspirin in 24 hours
B. Administer thrombolytic therapy immediately without further evaluation
C. Activate the cardiac catheterization team for emergent reperfusion
D. Schedule an outpatient stress test
Correct Answer: C. Activate the cardiac catheterization team for emergent reperfusion
Rationale
ST-elevation myocardial infarction (STEMI) requires immediate reperfusion therapy, preferably
primary percutaneous coronary intervention (PCI) when available within guideline-
recommended timeframes.
Question 2
A patient with type 2 diabetes has an HbA1c of 9.5% despite maximum-dose metformin therapy.
Which medication provides cardiovascular benefit in addition to lowering glucose?
A. Glyburide
B. Pioglitazone
C. Empagliflozin
D. Acarbose
Correct Answer: C. Empagliflozin
Rationale
,SGLT2 inhibitors such as empagliflozin improve glycemic control while reducing cardiovascular
events and slowing progression of chronic kidney disease.
Question 3
A 6-year-old child presents with fever, sore throat, tender anterior cervical lymph nodes, and
tonsillar exudates. Which diagnostic test should be performed first?
A. Chest radiograph
B. Rapid antigen detection test for Group A Streptococcus
C. Influenza PCR
D. Complete blood count
Correct Answer: B. Rapid antigen detection test for Group A Streptococcus
Rationale
Children meeting clinical criteria for streptococcal pharyngitis should undergo rapid antigen
testing before antibiotic treatment.
Question 4
A 72-year-old smoker has progressive dyspnea. Spirometry shows an FEV₁/FVC ratio of 0.60
after bronchodilator administration. Which diagnosis is most likely?
A. Asthma
B. Chronic obstructive pulmonary disease
C. Restrictive lung disease
D. Pulmonary fibrosis
Correct Answer: B. Chronic obstructive pulmonary disease
Rationale
Persistent airflow obstruction with a post-bronchodilator FEV₁/FVC ratio below 0.70 is
diagnostic of COPD.
Question 5
,A patient taking lisinopril develops facial swelling and difficulty swallowing. What is the most
appropriate action?
A. Continue medication and observe
B. Reduce the dose
C. Discontinue lisinopril immediately and treat as angioedema
D. Switch to another ACE inhibitor
Correct Answer: C. Discontinue lisinopril immediately and treat as angioedema
Rationale
ACE inhibitor-induced angioedema is a medical emergency requiring immediate discontinuation
of the medication and airway assessment.
Question 6
Which lipid-lowering medication is recommended as first-line therapy for reducing ASCVD
risk?
A. Niacin
B. Fenofibrate
C. Statins
D. Ezetimibe alone
Correct Answer: C. Statins
Rationale
Statins are first-line therapy because they significantly reduce LDL cholesterol and
cardiovascular morbidity and mortality.
Question 7
Which patient requires immediate emergency evaluation for possible meningitis?
A. Fever and rhinorrhea
B. Headache relieved with acetaminophen
C. Fever, neck stiffness, altered mental status, and photophobia
, D. Sinus congestion
Correct Answer: C. Fever, neck stiffness, altered mental status, and photophobia
Rationale
The classic presentation of meningitis includes fever, nuchal rigidity, altered mental status, and
photophobia, requiring urgent treatment.
Question 8
A 28-year-old pregnant woman at 14 weeks' gestation has asymptomatic bacteriuria. What is the
recommended management?
A. No treatment is necessary
B. Treat with an appropriate pregnancy-safe antibiotic
C. Repeat urine culture after delivery
D. Increase fluid intake only
Correct Answer: B. Treat with an appropriate pregnancy-safe antibiotic
Rationale
Asymptomatic bacteriuria during pregnancy should be treated to prevent pyelonephritis and
adverse pregnancy outcomes.
Question 9
Which vaccine should every adult receive annually unless contraindicated?
A. MMR
B. Influenza vaccine
C. Varicella vaccine
D. HPV vaccine
Correct Answer: B. Influenza vaccine
Rationale
Annual influenza vaccination is recommended for nearly all individuals aged 6 months and older.
QUESTIONS WITH
ANSWERS(SCORES 100%)
Course
Predictor
Question 1
A 58-year-old man with a history of hypertension presents with crushing substernal chest pain
radiating to his left arm for 45 minutes. His ECG demonstrates ST-segment elevation in leads II,
III, and aVF. What is the priority intervention?
A. Begin oral aspirin in 24 hours
B. Administer thrombolytic therapy immediately without further evaluation
C. Activate the cardiac catheterization team for emergent reperfusion
D. Schedule an outpatient stress test
Correct Answer: C. Activate the cardiac catheterization team for emergent reperfusion
Rationale
ST-elevation myocardial infarction (STEMI) requires immediate reperfusion therapy, preferably
primary percutaneous coronary intervention (PCI) when available within guideline-
recommended timeframes.
Question 2
A patient with type 2 diabetes has an HbA1c of 9.5% despite maximum-dose metformin therapy.
Which medication provides cardiovascular benefit in addition to lowering glucose?
A. Glyburide
B. Pioglitazone
C. Empagliflozin
D. Acarbose
Correct Answer: C. Empagliflozin
Rationale
,SGLT2 inhibitors such as empagliflozin improve glycemic control while reducing cardiovascular
events and slowing progression of chronic kidney disease.
Question 3
A 6-year-old child presents with fever, sore throat, tender anterior cervical lymph nodes, and
tonsillar exudates. Which diagnostic test should be performed first?
A. Chest radiograph
B. Rapid antigen detection test for Group A Streptococcus
C. Influenza PCR
D. Complete blood count
Correct Answer: B. Rapid antigen detection test for Group A Streptococcus
Rationale
Children meeting clinical criteria for streptococcal pharyngitis should undergo rapid antigen
testing before antibiotic treatment.
Question 4
A 72-year-old smoker has progressive dyspnea. Spirometry shows an FEV₁/FVC ratio of 0.60
after bronchodilator administration. Which diagnosis is most likely?
A. Asthma
B. Chronic obstructive pulmonary disease
C. Restrictive lung disease
D. Pulmonary fibrosis
Correct Answer: B. Chronic obstructive pulmonary disease
Rationale
Persistent airflow obstruction with a post-bronchodilator FEV₁/FVC ratio below 0.70 is
diagnostic of COPD.
Question 5
,A patient taking lisinopril develops facial swelling and difficulty swallowing. What is the most
appropriate action?
A. Continue medication and observe
B. Reduce the dose
C. Discontinue lisinopril immediately and treat as angioedema
D. Switch to another ACE inhibitor
Correct Answer: C. Discontinue lisinopril immediately and treat as angioedema
Rationale
ACE inhibitor-induced angioedema is a medical emergency requiring immediate discontinuation
of the medication and airway assessment.
Question 6
Which lipid-lowering medication is recommended as first-line therapy for reducing ASCVD
risk?
A. Niacin
B. Fenofibrate
C. Statins
D. Ezetimibe alone
Correct Answer: C. Statins
Rationale
Statins are first-line therapy because they significantly reduce LDL cholesterol and
cardiovascular morbidity and mortality.
Question 7
Which patient requires immediate emergency evaluation for possible meningitis?
A. Fever and rhinorrhea
B. Headache relieved with acetaminophen
C. Fever, neck stiffness, altered mental status, and photophobia
, D. Sinus congestion
Correct Answer: C. Fever, neck stiffness, altered mental status, and photophobia
Rationale
The classic presentation of meningitis includes fever, nuchal rigidity, altered mental status, and
photophobia, requiring urgent treatment.
Question 8
A 28-year-old pregnant woman at 14 weeks' gestation has asymptomatic bacteriuria. What is the
recommended management?
A. No treatment is necessary
B. Treat with an appropriate pregnancy-safe antibiotic
C. Repeat urine culture after delivery
D. Increase fluid intake only
Correct Answer: B. Treat with an appropriate pregnancy-safe antibiotic
Rationale
Asymptomatic bacteriuria during pregnancy should be treated to prevent pyelonephritis and
adverse pregnancy outcomes.
Question 9
Which vaccine should every adult receive annually unless contraindicated?
A. MMR
B. Influenza vaccine
C. Varicella vaccine
D. HPV vaccine
Correct Answer: B. Influenza vaccine
Rationale
Annual influenza vaccination is recommended for nearly all individuals aged 6 months and older.
